The identification of coronary artery disease among women by means of different forms of stress is often difficult due to the high prevalence of false-positive studies, particularly with the use of conventional stress tests. We have shown that transesophageal dobutamine stress echocardiography is an accurate technique for the evaluation of coronary artery disease in a population that predominantly included male patients. To determine the accuracy of this method for assessment of ischemic responses in women, we performed transesophageal echocardiography during combined infusion of increasing doses of dobutamine in 48 women (age 51plus/minus10 years) who underwent cardiac catheterization for evaluation of anginal chest pain. Of the 48 women, 10 had evidence of significant coronary artery disease and the remaining 38 had normal coronary angiograms. Dobutamine stress induced chest pain in 8 of the 10 women with coronary artery disease and in 37 of the 38 with normal coronary arteries. Of the 10 women with coronary artery disease, 8 developed regional wall motion abnormalities with dobutamine infusion. However, none of the women with normal coronary arteries had such an ischemic response. Thus, the sensitivity of the technique was 80% and the specificity was 100%. Hence, transesophageal dobutamine stress echocardiography is an accurate method for detection of coronary artery disease in women presenting with anginal chest pain.